At a Glance

Why Get Tested?

When to Get Tested?

As part of a regular health exam with a cholesterol test or lipid profile; at least once every five years in adults; children should have a lipid profile screening at least once between the ages of 9 and 11 and then again between the ages of 17 and 21.

Sample Required?

A blood sample drawn from a vein in your arm or from a fingerstick

Test Preparation Needed?

If this test is to be performed as part of a complete lipid profile, fasting for 9-12 hours typically will be required; only water is permitted. Follow any instructions you are given.

The Test Sample

What is being tested?

High-density lipoprotein (HDL cholesterol, HDL-C) is one of the classes of lipoproteins that carry cholesterol in the blood. HDL-C consists primarily of protein with a small amount of cholesterol. It is considered to be beneficial because it removes excess cholesterol from tissues and carries it to the liver for disposal. Hence, HDL cholesterol is often termed "good" cholesterol. The test for HDL cholesterol measures the amount of HDL-C in blood.

High levels of cholesterol have been shown to be associated with the development of hardening of the arteries (atherosclerosis) and heart disease. When cholesterol levels in the blood increase (not enough is removed by HDL), it may be deposited on the walls of blood vessels. These deposits, termed plaques, can build up, causing vessel walls to become more rigid, and may eventually narrow the openings of blood vessels, constricting the flow of blood.

A higher level of blood HDL-C can decrease the risk of developing plaques by removing excess cholesterol from the blood and lower the risk of heart attack or stroke.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes a drop of blood is collected by puncturing the skin on a fingertip. This fingerstick sample is typically used when HDL-C is being measured on a portable testing device, for example, at a health fair.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

Since this test is usually performed as part of a complete lipid profile, fasting for 9-12 hours before sample collection is typically required; only water is permitted. Follow any instructions you are given.

The Test

How is it used?

The test for high-density lipoprotein cholesterol (HDL-C) is used along with other lipid tests to screen for unhealthy levels of lipids and to determine the risk of developing heart disease.

HDL-C may also be monitored on a regular basis if previous test results have shown an increased risk for heart disease, if an individual has had a heart attack, or if someone is undergoing treatment for high cholesterol.

When is it ordered?

HDL-C may be ordered as a follow-up test to a high result on a cholesterol screening test. HDL-C is usually not ordered by itself but with other tests, including cholesterol, LDL cholesterol (LDL-C), and triglycerides as part of a lipid profile during a health checkup. It is recommended that all adults be tested at least once every five years.

HDL-C, as part of the lipid profile, may be ordered more frequently for those who have one or more risk factors for heart disease. Major risk factors include:

Cigarette smoking

Age (men 45 years or older or women 55 years or older)

Hypertension (blood pressure of 140/90 or higher or taking high blood pressure medications)

Family history of premature heart disease (heart disease in an immediate family member—male relative under age 55 or female relative under age 65)

Screening with a lipid profile is recommended for children as well as adults. Children should be tested at least once between the ages of 9 and 11 and once again between the ages of 17 and 21. As with adults, additional testing may be required for young people with other risk factors or if screening shows that levels are above the accepted levels. Some of the risk factors include a family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight. Doctors may order lipid profile screening for children under the age of 9 if a parent has high cholesterol, according to the American Academy of Pediatrics.

HDL-C levels may also be ordered at regular intervals to evaluate the success of lifestyle changes such as diet and exercise or smoking cessation aimed at increasing someone's level of HDL-C.

What does the test result mean?

For adults:

If HDL-C is less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L) for women, there is an increased risk of heart disease that is independent of other risk factors, including the LDL-C level.

A typical level of HDL-C is between 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5 mmol/L) for women and is associated with average risk of heart disease.

Based on many epidemiologic studies, HDL-C of 60 mg/dL (1.55 mmol/L) or higher is associated with a less than average risk of heart disease. The National Cholesterol Education Panel Adult Treatment Guidelines suggest that an HDL cholesterol value greater than 60 mg/dL is protective and should be treated as a negative risk factor. However, some recent studies suggest that high HDL-C is not universally protective (See Common Questions #2).

For children, teens and young adults:

If HDL-C is less than 40 mg/dL (1.04 mmol/L), there is an increased risk of heart disease that is independent of other risk factors, including the LDL-C level.

A level of HDL-C between 40 and 45 mg/dL (1.04-1.17 mmol/L) is borderline.

A level of HDL-C greater than 45 mg/dL (1.17 mmol/L) is acceptable.

Some laboratories report a ratio of total cholesterol to HDL cholesterol. The ratio is obtained by dividing the total cholesterol by the HDL cholesterol. For example, if a person has a total cholesterol result of 200 mg/dL and an HDL cholesterol level of 50 mg/dL, the ratio would be stated as 4 (or 4:1). A desirable ratio is below 5 (5:1); the optimum ratio is 3.5 (3.5:1). The American Heart Association recommends that the absolute numbers for total blood cholesterol and HDL cholesterol levels be used because they are more useful than the ratio in determining appropriate treatment for patients.

HDL should be interpreted in the context of the overall findings from the lipid profile and in consultation with the health care provider.

Is there anything else I should know?

A complete lipid profile requires fasting for 9-12 hours. If the testing occurs when a person is not fasting, only the HDL-C and total cholesterol values may be used for risk assessment.

HDL cholesterol should be measured when a person is not ill. Cholesterol is temporarily low during acute illness, immediately following a heart attack, or during stress (like from surgery or an accident). You should wait at least six weeks after any illness to have cholesterol measured.

In women, HDL cholesterol may change during pregnancy. Women should wait at least six weeks after having a baby to have HDL-C measured.

Common Questions

1. What treatments are recommended for low HDL-C levels?

Low HDL-C is not usually a target for treatment with medication. While some drugs used to lower LDL-C can also raise HDL-C, these drugs are not typically prescribed based on HDL-C levels. Certain lifestyle changes, however, may be recommended to help increase your HDL-C level. Since smoking can decrease HDL-C levels, quitting smoking (if you are a smoker) is a good way to increase HDL-C. Exercise is another good way to increase HDL-C. Alcohol consumption in moderation (1 to 2 drinks per day) has been reported to increase HDL-C, but there is some controversy about whether this is beneficial. Most physicians do not recommend increasing alcohol intake to increase HDL-C cholesterol.

2. My HDL-C is high. Is this a problem?

High HDL-C has generally been found to be protective, decreasing the risk of coronary artery disease (CAD) in most people. However, some recent studies have shown that in some people with high HDL-C, the HDL-C is not protective and may, in fact, result in higher risk for CAD than in people with normal HDL-C levels. In one study, it was shown that people with CAD and high HDL-C had underlying genetic anomalies in enzymes important in lipid turnover (cholesterol ester transfer protein and hepatic triglyceride lipase). Another study showed that high levels of abnormally large HDL-C particles were associated with increased risk of CAD. Further research is needed to determine what conditions contribute to unexpectedly high risk of CAD in the presence of high HDL-C.

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Article Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Sep 2002. PDF available for download at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf through http://www.nhlbi.nih.gov. Accessed July 21, 2013.

(December 2011) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics. December 2011. Vol 128. Supplement 5. PDF available for download at http://pediatrics.aappublications.org/site/misc/2009-2107.pdf through http://pediatrics.aappublications.org. Accessed July 21, 2013.

(November 2012) American Association of Family Physicians. High Cholesterol. Available online at http://familydoctor.org/familydoctor/en/diseases-conditions/high-cholesterol.html through http://familydoctor.org. Accessed July 19, 2013.

MayoClinic.com. Cholesterol Levels, What numbers should you aim for? (June 21, 2008). Available online at http://www.mayoclinic.com/health/cholesterol-levels/CL00001 through http://www.mayoclinic.com. Accessed July 2008.

Lia Tremblay (LifeWire). Are High HDL Levels the Answer to Cholesterol Problems? Why High HDL Levels May Not Be Good Enough. Available online at http://cholesterol.about.com/lw/Health-Medicine/Conditions-and-diseases/Is-Increasing-HDL-Levels-the-Answer-to-Cholesterol-Problems-.htm through http://cholesterol.about.com. Accessed May 2010.

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This article was last reviewed on August 26, 2013. | This article was last modified on December 29, 2014.

The review date indicates when the article was last reviewed from beginning to end to ensure that it reflects the most current science. A review may not require any modifications to the article, so the two dates may not always agree.

The modified date indicates that one or more changes were made to the article. Such changes may or may not result from a full review of the article, so the two dates may not always agree.